Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TFFunding None.
Background Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE neo/TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort.
Methods A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes.
Results Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, p = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, p = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, p = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, p = 0.752). However, higher numbers of PVL (mild—PER = 0.0% vs. NEO = 55.9%, p = 0.001; moderate or higher—PER = 0.0% vs. NEO = 6.8%, p = 0.119) after TAVI with NEO were observed.
Conclusion Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.
Keywordsaortic stenosis - aortic valve replacement - transcatheter aortic valve implantation - surgical aortic valve replacement - rapid deployment valve - Perceval - Symetis
S.G. and V.M. contributed to study design, data collection, data analysis and interpretation, and writing of the manuscript; both authors contributed equally to this work. E.K., M.A., K.E., and T.R. contributed to data collection and data analysis/interpretation. I. D., B.I., and C.G. contributed to collection of data and literature search. C.F., T.S., and N.M. contributed to data analysis and interpretation. S.B., O.L., and T. W. contributed to data analysis and interpretation, review, and correction of the manuscript.
* Both authors contributed equally to this work.
Received: 13 September 2020
Accepted: 25 November 2020
24 March 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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